Sba Form 4 - Application For Business Loan Page 2
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4ALL EXHIBITS MUST BE SIGNED AND DATED BY PERSON SIGNING THIS FORM
BUSINESS INDEBTEDNESS:
Furnish the following information on all outstanding installment debts, contracts, notes, and mortgages payable. Indicate by an asterisk (*)
items to be paid by loan proceeds and reason for paying them. (Present balance should agree with the latest balance sheet submitted).
Maturity
Current or
Rate of
Monthly
Original
Present
Security
To Whom Payable
Original
Date
Interest
Past Due
Date
Balance
Payment
Amount
$
$
$
Acct. #
$
$
$
Acct. #
$
$
$
Acct. #
$
$
Acct. #
$
$
$
$
Acct. #
MANAGEMENT
(Proprietor, partners, officers, directors all holder of outstanding stock - 100 % of ownership must be shown).
Use separate sheet if necessary.
Name and Social Security number
Complete Address
% Owned
*Gender
and Position/Title
*Veteran Status
Veteran
Yes
No
If yes, service-disabled? Yes
No
Asian
Black/Afr.-Amer.
Native Haw./Pacific Islander
White/Cauc.
Ethnicity *Hisp./Latino
Not Hisp./Latino
Race*:
Amer. Ind./Alaska Native
*Veteran Status
Veteran
Yes
No
If yes, service-disabled? Yes
No
Race*:
Amer. Ind./Alaska Native
Asian
Black/Afr.-Amer.
Native Haw./Pacific Islander
White/Cauc.
Ethnicity *Hisp./Latino
Not Hisp./Latino
*Veteran Status
Veteran
Yes
No
If yes, service-disabled? Yes
No
Race*:
Amer. Ind./Alaska Native
Asian
Black/Afr.-Amer.
Native Haw./Pacific Islander
White/Cauc.
Ethnicity *Hisp./Latino
Not Hisp./Latino
*Veteran Status
Veteran
Yes
No
If yes, service-disabled? Yes
No
Race*:
Amer. Ind./Alaska Native
Asian
Black/Afr.-Amer.
Native Haw./Pacific Islander
White/Cauc.
Ethnicity * Hisp./Latino
Not Hisp./Latino
*This data is collected for statistical purpose only. It has no bearing on the credit decision. Disclosure is voluntary. One or more boxes for race may be selected.
Also, include the tax i.d. number [EIN or Social Security Number
For Guaranty Loans please provide an original and one copy (Photocopy is
(SSN)] Label it Exhibit B.
Acceptable) of the Application Form and all Exhibits to the participating
Lender. For Direct Loans submit one original copy of the application and
4. Include the financial statements listed below: a,b,c for the last
Exhibits to SBA.
three years; also a,b,c, and d as of the same date, - current within
90 days of filing the application; and statement e, if applicable.
All
1. Submit SBA Form 912 (State of Personal History) for each
information must be signed and dated. (a) Balance Sheet; (b) Profit
proprietor (if sole proprietorship), partner (if a partnership), and by each
and Loss Statement (if not available, explain why and substitute
officer, director, and owner of 20% or more of the company's stock (if a
Federal income tax forms); (c) Reconciliation of Net Worth; (d)
corporation, limited liability company or development company).
Aging of Accounts Receivable and Payable (summary); (e)
Projection of earnings for at least one year where financial
2. If your collateral consists of (A) Land and Building, (B) Machinery and
statements for the last three years are unavailable or when SBA
Equipment, (C) Furniture and Fixtures, (D) Accounts Receivable, (E)
requests them, Label it Exhibit C. (Contact SBA for a referral if
assistance with preparation is wanted.)
Inventory, (F) Other, please provide an itemized list that contains serial
and identification numbers for all articles that had an original value
greater than $5,000. Include a legal description of Real Estate
5. Provide a brief history of your company and a paragraph
offered as collateral. Label it Exhibit A.
describing the expected benefits it will receive from the loan.
Label
it Exhibit D.
3. Furnish a signed current personal balance sheet (SBA Form 413
6. Provide a brief description similar to a resume of the education,
may be used for this purpose) for (1) each proprietor; or (2) each limited
technical and business background for all the people listed under
partner who owns 20% or more interest and each general partner; or (3)
Management. Label it Exhibit E.
each stockholder owning 20% or more of voting stock. Include the
assets and liabilities of the spouse and any minor children.
SBA Form 4 (9-09) Previous Edition Obsolete
Page 2
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